Follicular occlusion disorders in Down syndrome patients.

Disorders involving follicular occlusion, such as hidradenitis suppurativa, folliculitis, acneiform eruptions, and pilonidal cysts, have shown an increased prevalence in the Down syndrome (DS) population, but there are limited published data examining this association. We conducted a retrospective chart review of 243 DS patients presenting to a pediatric dermatology clinic to further examine the prevalence of disorders of follicular occlusion in DS patients. Our study showed high rates of disorders of follicular occlusion in DS patients, with prevalent disorders including folliculitis (21.0%), keratosis pilaris (17.3%), acne vulgaris (11.1%), hidradenitis suppurativa (7.0%), and furunculosis (4.5%), and overall prevalence of 44.9%. These findings add to a limited but growing body of evidence that documents an increased rate of disorders of follicular occlusion in pediatric DS patients.

A barrier to care: Distance traveled affects adherence to treatment and follow-up plans for patients with infantile hemangioma.

A chart review was performed of all patients diagnosed with infantile hemangioma in the pediatric dermatology clinic to determine whether distance traveled by the patient affected adherence to follow-up and treatment plans. An increase in distance was associated with an increase in likelihood of nonadherence to treatment or follow-up plans. Compared to patients who lived within 10 miles of a pediatric dermatologist, families who lived farther away were less likely to adhere to treatment plans. Families who traveled over 20 miles to clinic were 7.38 times more likely to be nonadherent to the treatment plan than those who traveled 0-10 miles.

The triad of pruritus, xanthomas, and cholestasis: Two cases and a brief review of the literature.

When encountered in children, xanthomas are most commonly associated with a group of disorders known as familial hyperlipidemias. Aside from cosmetic concerns, these xanthomas are typically asymptomatic, but when generalized pruritus is a prominent associated symptom, clinicians should consider a different set of diagnoses that includes cholestasis of the liver. In this article we present two illustrative cases of children with cholestatic disease, pruritus, and xanthomas and discuss other disorders that may include this triad.

Gaucher Disease Type 2 Presenting with Collodion Membrane and Blueberry Muffin Lesions.

Collodion membrane is most closely associated with forms of autosomal recessive congenital ichthyosis, but the differential diagnosis includes many other less common etiologies. Herein we present a case of Gaucher disease (GD) type 2 in a neonate presenting with collodion membrane in addition to blueberry muffin lesions. The clinical presentation and etiology of GD and the differential diagnoses for collodion membrane and blueberry muffin lesions are briefly reviewed.

Experience with Holter monitoring during propranolol therapy for infantile hemangiomas.

BACKGROUND: Although adverse events in children treated with propranolol have proven rare, the appropriate methods of assessing cardiovascular risk and monitoring for toxicity when the medication is used for infantile hemangiomas remain unclear. OBJECTIVE: We sought to analyze Holter monitor reports of otherwise healthy patients on propranolol for infantile hemangiomas to determine the incidence of sustained arrhythmias and to evaluate the utility of Holter monitoring in the outpatient setting. METHODS: We retrospectively reviewed the charts of patients with infantile hemangioma who underwent 24-hour Holter monitoring after initiation or dose escalation of propranolol between 2011 and 2014. RESULTS: In all, 43 patients aged 1.8 to 36.2 months, with 44 Holter monitor reports, were included in the study. No sustained arrhythmias were revealed. The treatment plan was not altered in any patient based on the Holter monitor report. LIMITATIONS: This was a retrospective study design. CONCLUSION: Our study suggests that Holter monitoring may be unnecessary in otherwise healthy patients with infantile hemangioma older than 12 weeks who are treated with propranolol in the outpatient setting.

Tuberous Sclerosis Complex: An Update for Dermatologists.

Tuberous sclerosis complex is an autosomal dominant disorder that often manifests early in life with cutaneous features, and it is important that dermatologists who care for children remain up to date on its diagnosis and management. This article provides an update regarding the most recent guidelines for diagnosis published by the International Tuberous Sclerosis Complex Consensus Conference, which took place in 2012, and provides a brief literature review of the most recent developments in the treatment of skin findings.

The curette prep: a modification of the traditional scabies preparation.

An accurate diagnosis of scabies is critical for proper treatment of this common infestation. In our clinic, we have developed a modification of the traditional method of performing a scabies preparation, called the curette prep, that substitutes a disposable curette for a scalpel blade when obtaining skin scrapings for examination. The major advantages of this technique are greater acceptability and safety for pediatric patients.

Abnormal wound healing related to high-dose systemic corticosteroid therapy in a patient with Ehlers-Danlos syndrome benign hypermobility Type.

The adverse impact of chronic corticosteroid therapy on wound healing has been well characterized, as has abnormal wound healing known to occur in the classic type of Ehlers-Danlos syndrome (EDS). In contrast, abnormal wound healing is absent in cases of EDS benign hypermobility type (EDS-BHT). We present the case of a patient with EDS-BHT with no history of abnormal wound healing who developed large nonhealing ulcers to sites of minor trauma after initiating therapy with high-dose systemic corticosteroids for dermatomyositis. This case provides a dramatic illustration of the effects of chronic systemic corticosteroids on skin fragility and wound healing in a patient with an underlying genetic defect of the connective tissue.

Need for Primary Prevention for Skin Cancers in Iran.

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Skin cancer prevention practices among malignant melanoma survivors: a systematic review.

PURPOSE: This systematic review was conducted to evaluate and summarize the existing literature on prevalence of ultraviolet radiation (UVR) exposure, sun protection, and screening behaviors among individuals diagnosed with malignant melanoma (MM). METHODS: The search was performed in PubMed, CINAHL, PsycINFO, ScienceDirect, EMBASE, and ERIC from inception of each database through July 2014. Studies were included if (1) individuals diagnosed with MM were the primary sample, (2) measured UVR exposure, primary and secondary preventive behaviors, (3) original research communication that constitutes an entire set of empirical data, (4) observational design, and (5) English peer-reviewed. Studies were excluded if (1) all of the inclusion criteria were not met and (2) duplicates, conference abstracts, editorials, news, letters to the editor, comments, reviews, feature articles, white papers, and guidelines. RESULTS: The search resulted in 255 articles that were screened for relevance; however, only 15 articles met all of the inclusion criteria. Most of the studies were cross-sectional (n = 10), used self-administered surveys (n = 8), and were conducted in North America (n = 10). The sample sizes ranged considerably, but were mostly Caucasian (n = 6) and included a higher proportion of women (n = 8). Evidence demonstrated that individuals with MM still engaged in sunbathing, indoor tanning, and reported sunburns. Moreover, survivors reported inadequate levels of both sun protection and skin self-examinations. CONCLUSIONS: The findings highlight the need for intensifying intervention strategies to reduce the risk of new primary MMs in this group. Future research should increase in rigor and include more diverse populations and regions.

Sun-related behaviors among individuals previously diagnosed with non-melanoma skin cancer.

Compared to the general population, the risk of developing non-melanoma skin cancer is considerably higher among individuals with a previous history of this condition. Protection from ultraviolet (UV) radiation is the primary evidence-based approach for minimizing this risk. This review was aimed to assess the prevalence of sun-safe behaviors in non-melanoma skin cancer survivors. Searches were conducted in six electronic databases including PubMed, Psyclnfo, CINAHL, EMBASE, ERIC and Science Direct. A narrative approach was adopted to synthesize the data. The findings demonstrated that respondents do not protect themselves optimally from UV radiation exposure. Low levels of perceived skin cancer risk, a lack of knowledge about effective sun protection strategies and the inconvenience associated with sun-safe behaviors appear to explain this finding. A note of caution is required here, as there is a potential for publication bias. Moreover, the results of this study cannot be generalized to all non-melanoma skin cancer patients. Skin cancer survivors must be educated about their increased risk of future skin cancers. Behavioral interventions must be developed to increase the adoption of skin protective behaviors in this high-risk population group.

Retrospective comparison of azithromycin, clarithromycin, and erythromycin for the treatment of foals with Rhodococcus equi pneumonia.

The objective of this retrospective study was to compare the efficacy of azithromycin-rifampin, clarithromycin-rifampin, and erythromycin-rifampin for the treatment of pneumonia caused by Rhodococcus equi in foals. Eighty-one foals with naturally acquired pneumonia caused by R. equi were included in the study. Information on age, sex, breed, physical examination findings, laboratory testing, and thoracic radiography was abstracted from each medical record. Foals were divided in 3 groups based on the antimicrobial agent selected for therapy. Short-term (discharge from the hospital) and long-term (apparently healthy as a yearling) success rates, days of hospitalization, days with fever, days with tachypnea, and percentage of radiographic improvement were compared among groups. Foals treated with clarithromycin-rifampin had significantly (P = .02) higher odds of overall short-term (odds ratio [OR] = 12.2) and long-term (OR = 20.6) treatment success and significantly fewer days with fever than foals treated with erythromycin-rifampin. Foals treated with clarithromycin-rifampin had a significantly (P = .03) higher percentage of radiographic improvement and a tendency (P = .06) toward higher odds of overall short-term (OR = 8.1) and long-term (OR = 11.8) treatment success compared to foals treated with azithromycin-rifampin. Among foals with severe radiographic lesions, the success rates of foals treated with clarithromycin-rifampin both short-term (88%) and long-term (83%) were significantly (P = .02) higher than that of foals treated with azithromycin-rifampin (0%). For each treatment group, the only reported adverse effect was diarrhea that was mild and self-limiting in most cases. The combination clarithromycin-rifampin is superior to azithromycin-rifampin or erythromycin-rifampin for the treatment of pneumonia caused by R. equi in foals in a referral population.

Body weight, hematologic findings, and serum and plasma biochemical findings of horses competing in a 48-, 83-, or 159-km endurance ride under similar terrain and weather conditions.

OBJECTIVE: To compare physiologic, hematologic, and selected serum and plasma biochemical variables obtained from horses competing in 48-, 83-, or 159-km endurance rides before competition and at the same cumulative distance points. ANIMALS: 83 horses. PROCEDURE: Weight and rectal temperature measurements and blood samples were obtained from horses before, during, and after 1 of 3 rides conducted on the same day. Plasma protein (PP), lactate, WBC, serum electrolyte, and calcium concentrations; PCV; and creatine kinase (CK) activity were determined. Assessments were made to determine whether any differences among groups, with respect to total distance competed, could be explained by differences in lap speed or conditioning and to investigate the effect of time in transit or on-site prior to competition on results of blood analyses or competition outcome. RESULTS: Horses in the 159-km distance group had the lowest preride serum sodium, chloride, bicarbonate, and calcium concentrations. As hours in transit increased, preride PP concentration was significantly greater; serum sodium, chloride, and bicarbonate concentrations were lower; CK activity at 159 km was greater; and horses were more likely to be eliminated. The preride sodium was significantly greater in horses that completed the ride, compared with those eliminated. CONCLUSIONS AND CLINICAL RELEVANCE: Among distance groups, distance ridden, speed, level of fitness, and years of experience of horses had little effect on the variables examined. Electrolyte and water supplementation and earlier arrival at the event may be beneficial for horses that are transported long distances to endurance competition.

Effects on plasma endotoxin and eicosanoid concentrations and serum cytokine activities in horses competing in a 48-, 83-, or 159-km endurance ride under similar terrain and weather conditions.

OBJECTIVE: To determine plasma endotoxin concentration in horses competing in a 48-, 83-, or 159-km endurance race and its importance with regard to physical, hematologic, or serum and plasma biochemical variables. ANIMAL: 3 horses. PROCEDURE: Weight and rectal temperature measurements and blood samples were obtained before, during, and after exercise. Blood samples were analyzed for plasma endotoxin concentration; serum antiendotoxin antibody titers; thromboxane B2 (TxB2) and 6-keto-prostaglandin F1alpha (PGF1alpha) concentrations; tumor necrosis factor alpha (TNFalpha) and interleukin-6 (IL-6) activities; WBC, plasma protein, lactate, serum electrolyte, and calcium concentrations; PCV; and creatine kinase activity. RESULTS: Detection of plasma endotoxin increased during exercise for horses competing at all distances but occurred more frequently in the 48- and 83-km groups. Plasma lactate concentration was significantly greater when endotoxin was concurrently detected. Endotoxin in plasma was not significantly associated with success of race completion. Plasma TxB2 and PGF1alpha concentrations and serum IL-6 activity significantly increased with exercise. Horses that had an excellent fitness level (as perceived by their owners) had greater decreases in serum antiendotoxin antibody titers during exercise than did horses perceived as less fit. In horses with better finish times, TxB2 and PGF1alpha concentrations were significantly greater and TNFalpha activity was significantly less than that of slower horses. CONCLUSIONS AND CLINICAL RELEVANCE: Endotoxemia developed during endurance racing, but was significantly correlated with increased plasma lactate concentration and not with other variables indicative of endotoxemia. Plasma TxB2 and PGF1alpha concentrations and serum TNFalpha activity may be associated with performance success.

West Nile virus encephalomyelitis in horses: 46 cases (2001).

OBJECTIVE: To determine signalment, clinical findings, results of diagnostic testing, outcome, and postmortem findings in horses with West Nile virus (WNV) encephalomyelitis. DESIGN: Retrospective study. ANIMALS: 46 horses with WNV encephalomyelitis. PROCEDURE: Clinical data were extracted from medical records of affected horses. RESULTS: On the basis of clinical signs and results of serologic testing, WNV encephalomyelitis was diagnosed in 46 of 56 horses with CNS signs. Significantly more males than females were affected. Increased rectal temperature, weakness or ataxia, and muscle fasciculations were the most common clinical signs. Paresis was more common than ataxia, although both could be asymmetrical and multifocal. Supportive treatment included anti-inflammatory medications, fluids, antimicrobials, and slinging of recumbent horses. Results of the IgM capture ELISA and the plaque reduction neutralization test provided a diagnosis in 43 horses, and only results of the plaque reduction neutralization test were positive in 3 horses. Mortality rate was 30%, and 71% of recumbent horses were euthanatized. One horse that had received 2 vaccinations for WNV developed the disease and was euthanatized. Follow-up communications with 19 owners revealed that most horses had residual deficits at 1 month after release from the hospital; abnormalities were resolved in all but 2 horses by 12 months after release. CONCLUSIONS AND CLINICAL RELEVANCE: Our findings were similar to those of previous WNV outbreaks in horses but provided additional clinical details from monitored hospitalized horses. Diagnostic testing is essential to diagnosis, treatment is supportive, and recovery rate of discharged ambulatory horses is < 100%.

A case of a generalized lichenoid tattoo reaction.

Cutaneous reactions to tattoos have been increasing in conjunction with the rise in popularity of tattoos. While localized lichenoid reactions to tattoo inks are fairly common, generalized lichenoid reactions are relatively rare. Herein the authors present a case of a generalized lichenoid reaction to a tattoo containing only black ink. They also present a brief discussion of tattoo reactions and treatment options.